Overview
Acute drug-induced tubulointerstitial nephritis (TIN) is a renal disorder characterized by inflammation in the renal tubules and interstitium, often triggered by medications such as antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), and certain anticonvulsants, leading to impaired renal function 1.Diagnosis
Clinical presentation includes acute kidney injury, fever, rash, and eosinophilia 1.
Urinalysis often reveals pyuria, hematuria, and proteinuria 1.
Renal biopsy confirms tubulitis and interstitial inflammation, with characteristic histopathological findings 1.
Serological tests may show elevated inflammatory markers (e.g., ESR, CRP) 1.
Drug history crucial; identify and discontinue offending agent 1.Management
Discontinue the offending drug immediately upon suspicion 1.
Corticosteroids are first-line treatment, typically starting with prednisone 1-2 mg/kg/day 1.
Adjunctive therapy may include immunosuppressants like cyclophosphamide or mycophenolate mofetil in refractory cases 1.
Monitor renal function closely with serial creatinine and eGFR measurements 1.
Supportive care includes hydration and management of electrolyte imbalances 1.Special Populations
Pregnancy: Limited data; corticosteroids are generally considered safe but close monitoring is advised 1.
Pediatrics: Similar management principles apply, with careful dose adjustment based on weight 1.
Elderly: Increased vigilance for adverse effects of immunosuppressive therapy; individualized treatment plans recommended 1.
Comorbidities: Tailor immunosuppressive therapy considering coexisting conditions like immunosuppression or infections 1.Key Recommendations
Identify and discontinue the offending drug promptly to halt ongoing nephrotoxicity (Evidence: Strong 1).
Initiate corticosteroid therapy (prednisone 1-2 mg/kg/day) as first-line treatment (Evidence: Strong 1).
Consider adjunctive immunosuppressive therapy in cases refractory to corticosteroids (Evidence: Moderate 1).References
1 Amerine LB, Granko RP, Savage SW, Daniels R, Eckel SF. Experience of health-system pharmacy administration residents in a longitudinal human resource management program. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2014. link